| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
3,538 |
3,488 |
$170K |
| D0120 |
Periodic oral evaluation - established patient |
2,825 |
2,789 |
$77K |
| D1206 |
Topical application of fluoride varnish |
2,724 |
2,681 |
$67K |
| D0272 |
Bitewings - two radiographic images |
857 |
844 |
$25K |
| D1208 |
Topical application of fluoride, excluding varnish |
608 |
606 |
$17K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
213 |
210 |
$12K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
85 |
54 |
$10K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
467 |
448 |
$9K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
46 |
26 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
133 |
128 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
55 |
53 |
$2K |
| D0330 |
Panoramic radiographic image |
15 |
15 |
$892.00 |
| D0274 |
Bitewings - four radiographic images |
12 |
12 |
$414.00 |
| D1999 |
|
203 |
195 |
$0.00 |